“Doctor, just one more vial! Please can you make my lips a little bit bigger? I think they will look even better, don't you agree?”

Another patient who has been overserved and is overdone wants larger lips, more cheek fillers, or another nose job. They praise, flatter, and fluff you. They are more than willing to pay full price. But you know they don't need it. It will make them appear more unnatural and divert from their ultimate goal. But can you resist? Can you say, “No”?

The power and benefits of saying no are much greater than it initially seems. When passionately pressed with an ambiguous, poorly defined, or imprudent request from someone whom we care about, saying “Yes” seemingly is the easy option. It complies, pleases, and avoids hurting another's feelings. We believe it puts us in good graces, garners us favors. And, “Yes” may satisfy an itch wanting to be scratched. But the reality is saying yes too easily often does the opposite of what we want. It sets unrealistic expectations, breeds failure, and leads to even more heartache. Eventually it ends in ill will. And, at extremes, saying yes can land us in risky and/or dangerous situations, whether physically, legally, or financially.

On the appropriate occasions when we say no, we mark a comforting and reliable boundary. It declares what we are willing to do or accept. Saying no means respect, honesty, and care for the other person. But equally as importantly, saying no establishes a space of respect for ourselves.

The word “No” is functional and beneficial professionally, and paradoxically it often leads to gaining more patients, as a reputation for honesty ensues. Patients want to know and see the doctor who is going to put their best interests first. Additionally, while saying no can lead to professional growth, it is equally if not more valuable in our personal, familial, and romantic lives. By saying no, we tell the other person we love them—whether it is a child disciplined with a midnight curfew, a best friend who asks you to compromise your ideals, or a loved one that wants you to join them on a vegan, no alcohol, no singing, no dancing, colonic retreat.

However, there is one key component that is often overlooked and is essential to unlocking all the benefits of the word “No.” It is critical to reveal the reason behind your “No,” or in other words the why to your “No.”

Whether it is a patient (“No, I think that more fillers won't enhance your attractiveness and in fact may make you look unnatural.”) or your child (“No, I don't want you out after midnight, when a higher proportion of drunk drivers are on the road and I care about your safety.”) or a friend (“No, my strategy is to only put money into projects that I am an expert in.”), when you tell someone the why behind your no, it helps them to understand your reasoning. And it allows you a better and more honest relationship afterward.

Also, the why behind your no sets the table for compromise. If the other person knows why you said no, then they can offer an alternative that meets or satisfies your why. This may lead to a middle path forward. Meaningful compromise is always front and center, leading to the most impactful advancements in diplomacy as well as the skill we most often revere in our leaders.

When I have had to say, “No” on occasion, I have been surprised at how my relationships—whether with patients, staff, friends, colleagues, or romantically—are strengthened. It is the relationships in which I have quickly offered a “Yes,” trying so hard to please and subsequently failing, that I most regret. While gaining comfort uttering the word, “No” may not be inherent or easy for most, with time and judicious use, something curious starts to happen—you begin to receive a lot more of what you want.

Consider it and let me know how “No” works for you.

—Steve Dayan, MD
Co-Chief Medical Editor